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Urbanization, armed conflict, and deforestation in African countries have increased the risk of zoonotic infections, which requires a One Health approach focused on the environment, animal health and human health.

IntroductionCochrane Africa (https://africa.cochrane.org/) aims to increase Cochrane reviews addressing high priority questions in sub-Saharan Africa (SSA). Researchers residing in SSA, despite often drawing on Cochrane methods, training or resources, conduct and publish systematic reviews outside of Cochrane. Our objective was to investigate the extent to which Cochrane authors from SSA publish Cochrane and non-Cochrane reviews.MethodsWe conducted a bibliometric study of systematic reviews and overviews of systematic reviews from SSA, first by identifying SSA Cochrane authors, then retrieving their first and last author systematic reviews and overviews from PubMed (2008 to April 2019) and using descriptive analyses to investigate the country of origin, types of reviews and trends in publishing Cochrane and non-Cochrane systematic reviews over time. To be eligible, a review had to have predetermined objectives, eligibility criteria, at least two databases searched, data extraction, quality assessment and a first or last author with a SSA affiliation.ResultsWe identified 657 Cochrane authors and 757 eligible systematic reviews. Most authors were from South Africa (n=332; 51%), followed by Nigeria (n=126; 19%). Three-quarters of the reviews (71%) were systematic reviews of interventions. The intervention reviews were more likely to be Cochrane reviews (60.3% vs 39.7%). Conversely, the overviews (23.8% vs 76.2%), qualitative reviews (14.8% vs 85.2%), diagnostic test accuracy reviews (16.1% vs 83.9%) and the ‘other’ reviews (11.1% vs 88.9%) were more likely to be non-Cochrane reviews. During the study period, the number of non-Cochrane reviews increased more than the number of Cochrane reviews. About a quarter of the reviews covered infectious disease topics.ConclusionCochrane authors from SSA are increasingly publishing a diverse variety of systematic reviews and overviews of systematic reviews, often opting for non-Cochrane journals.

Mobile health (mhealth) tools delivered through wireless technology are emerging as effective strategies for delivering quality training, ensuring rapid clinical decision making, and monitoring implementation of simple and effective interventions in under-resourced settings. We share our early experience of developing and deploying the InStrat COVID-19 health worker training application (App) in Ogun State, Western Nigeria where the country's first COVID-19 case was reported. This App was designed to directly provide frontline health workers with accurate and up-to-date information about COVID-19; enable them to quickly identify, screen and manage COVID-19 suspects; provide guidance on specimen collection techniques and safety measures to observe within wards and quarantine centers dealing with COVID-19. The App was deployed in 271 primary health care facilities in Ogun state and a total of 311 health workers were trained to use it. Of the 123 health workers who completed knowledge pre- and post-tests, their average test score improved from 47.5 (±9.4) to 73.1(±10.0) %, P < 0.0001 after using the tutorial. Rapid adoption and uptake were driven largely by public-private sector involvement as well as certification of health workers with reported satisfaction levels of over 95% among those who completed pre- and post-test surveys. Challenges encountered included a lack of universal availability of android phones for frontline health workers, lack of internet access in remote areas and a need to incentivize the workers. The timely deployment of this App targeting primary health care workers, mostly in hard-to-reach areas, obviated the need for conventional didactic training with potential of savings in training costs and time and could be applied to similar contexts.

BackgroundAs part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR.MethodsIn this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert’s scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score ResultsA total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.ConclusionsOur study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria’s NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.

Across Africa, there is some evidence of COVID-19 private sector activities to tackle COVID-19 which include the development of rapid diagnostic kits, deployment of e-health platforms for bespoke health workforce training, disease surveillance, reporting, auto-screening and advisories. Inequities in living and access to care by disadvantaged populations in the rural areas have been ameliorated by multi-pronged responses such as that mounted by the Joseph Ukpo Hospitals and Research Institute (JUHRI) in Nigeria. The provision, production and donation of personal protective equipment (PPE), the production of hand sanitizers and the engagement of the local community in the process represents an effective strategy to contain COVID-19, protect health workers and provide pathways for economic support for people whose sources of income have been upended during the pandemic. The JUHRI experience underpinned by Catholic medical ethics provides concrete evidence of the value of private sector participation in dealing with public health emergencies.

Background and Objectives: The World Health Organization estimates that 2 million health-care workers (HCWs) are at risk of occupational exposure to hepatitis B virus (HBV), with the majority (90%) of such infections arising in sub-Saharan Africa. This study aimed to determine HBV knowledge and vaccination uptake among HCWs. Materials and Method: This was a cross sectional analytical study conducted among 392 HCWs from two major health institutions in Calabar i.e. the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC), Cross river State. Multi-staged sampling method comprising of two stages was used to recruit participants into the study. The study population comprised of doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Study Design: This was a cross-sectional, study of HCWs in Calabar. Sampling Method: Multi-staged sampling method was used to select participants from two major health institutions in Calabar, i.e., the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC). Thereafter, through balloting, simple random sampling technique was used to recruit the participants. Study Population: Three hundred and ninety-two HCWs were recruited from UCTH and GHC under the following categories: doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. Data Management: A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Results: Overall, 67.9% of the respondents were found to have adequate knowledge of HBV vaccination and infection. Less than half (43.4%) of HCWs admitted receiving three doses (i.e., full coverage) of the vaccine. Difficulty in accessing the vaccine (48, 23.4%) was identified as the major reason given for suboptimal vaccination. Conclusion: The knowledge of HBV infection and vaccination is quite modest among HCWs in Calabar. Despite this observation, the vaccination status among HCWs is unsatisfactory. The implication of the findings of our study for health policy and practice is to prevent further occupational exposure of HCWs to HBV infection through mandatory vaccination.